Healthcare Provider Details

I. General information

NPI: 1992630107
Provider Name (Legal Business Name): KENDELL DEVAR KING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 BENTLEY DR
BAKER LA
70714-5041
US

IV. Provider business mailing address

5550 BENTLEY DR
BAKER LA
70714-5041
US

V. Phone/Fax

Practice location:
  • Phone: 225-341-9190
  • Fax:
Mailing address:
  • Phone: 225-341-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number008960357
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: